Surgical Mgmt of GL Flashcards
Surgery is the primary approach for what 2 GL?
- Infantile
2. Pupillary-block glaucoma
Laser trabeculoplasty works well in what 3 GL?
- POAG
- Pigmentary
- PXE
(aphakic and pseudophakic responds less favorably than phasic)
More pigmented TM requires what type of power for ALT or SLT?
LESS ENERGY
What are the settings for ALT?
50 um at 0.1 duration, 300-1000mW; produce a tiny bubble; 180 degrees = 40-50 applications
What are the settings for diode laser?
75um beam; 600-1000 mW for duration of 0.02 seconds.
How does SLT work?
The laser targets intracellular melanin.
What are the settings for SLT?
A frequency doubled (532-nm) Q switched Nd:Yag laser with 400 um spot size used to deliver 0.4-1.0 mJ of energy for 0.3 ns.
What are risk factors for “wipe out”?
Advanced age
Preoperative VF with macular splitting
Early post-operative hypotony AND elevated IOP
What is the goal of trabeculectomy?
Complete healing of the epithelial and conjunctival wound with INCOMPLETE healing of the scleral wound.
When should topical steroids be d/c after filtering surgery?
Tapered according to the degree of conjunctival hyperemia.
What are the 2 relative contraindications for combined CE and GL surgery?
- GL that requires a very low target IOP
2. Advanced GL with uncontrolled IOP and immediate need for successful reduction in IOP
What are 2 nonvalved shunts?
Molteno and Baerveldt
Borderline corneal endothelial function is a relative contraindication for what?
Tube-shunt surgery
What are the parameters for cyclophotocoagulation (diode laser)?
17-19 applications placed 270 degrees around the limbus with a power of 1.5-2W and a duration of 2 seconds.
How far posterior to the limbus is a small scleral incision amde for cyclodialysis cleft?
4mm
